HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE fI�NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: AAX \ Permit Number:
_ RECEIVED JUL 1 v) 21017
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line �q�
PROPOSED IMPROVEMENT LOCATION: .
Address: 550 0 v��- �,STip
Legal Description:
Property Tax ID#: 7®�- \" D - Lot No.
Site Plan Name: \- Block No.
Project Name:�Aix
Setbacks Front Back: Right Side: Left Side:
DETAILED-DESCRIPTION OF WORK:
F.QlQ�9•�e_ & � %-447— iiv: �/w 3'�o N NS . w, `(; �=e�/
CONSTRUCTION. INFORMATION:
Additiorlal work to be nerformed under this permit-check.a apply:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric ❑ Plumbing OSprinklers E]Generator Roof Roof pitch
Total Sq. Ft of Constructions SFt.of First Floor:
Cost of Construction.$�a'�^'° UtilitiesbSewer Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name 15 Name: CA VIN
Addres: ��i�- VV�•1 ` �`+�L— Company: IL
v\"S City: O,r State: Addre L, 13,v�1
Zip Code:, �Ka- Fax: City: r�S� �- Stater
Phone No. ��a `�c�-tom Zip Code, LiaW QFaax:
E-Mail: N` Phone No. - A 04
Fill in fee simple Title Holder on next page(if different E-Mail: VAMS
from the Owner listed above) State or County License: 1.
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
°SUPPLEMENTAL.CONSTRUCTION LIEN-.LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, 1 do hereby agree that 1 will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
s
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIp A STATE OF FLOR2�A ,
COUNTY OF COUNTY OF Lyc
The fo�r-oin instr ment was acknowledge before me The forgoing instru ent was acknowledged before me
this`\ \ day of Q\3 20 by this `R day of J J �� ,20 (1 by
cn,es`ef
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Publi -State of Florida) (Signature of Notaryublic-State of Florida)
Personally Known OR Produced Identification Personally Knownu• r'v�e 'dtlfic2ti3Fe.
Type of Identification Produced1zr _ _— Type of IdentificattOY� ed �NN BRIE GIVENS
DEANNAMARIC(ii`JENS I :*c o F U1023
�. - EXPIRES:De ber 2020
Commission No. I ' (S FGo22oz3 � Commission No. �� dedThruNota ��
C0MPu11SS L,
EXPIRES:December 16,202C rdenir ,ter,
off= BondedlhniNotary PubicUnderwrtsrs
F'
Revised 07/15/2014
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DATE
COMPLETE
INITIALS